HIV and AIDS

HIV means 'human immunodeficiency virus'. This is the virus that causes AIDS. HIV attacks some of the human cells that are vital to a healthy immune system

By
Dr David Delvin

20/07/2016

Peter DazeleyGetty Images

It is now clear that the outlook for people who have HIV has improved significantly in recent years. At a London conference in June 2016, it was revealed that early and continuous treatment of men and women who have the virus leads to a greatly increased life-span. British experts now think that it's best to get people onto treatment with combinations of anti-viral drugs as soon as they have been diagnosed as HIV-positive, so that they can live long and healthy lives. Furthermore, this early treatment with modern HIV drugs substantially reduces the partner's chances of getting the virus. Indeed, a South African research paper – published in the summer of 2016 – showed that giving these drugs to people who have HIV reduces the chances of transmission to their sexual partners by 77%. However, if you have HIV it is still vitally important to:

use condoms whenever you have sex

avoid having multiple partners.

What is HIV?

HIV means 'human immunodeficiency virus'. This is the virus that is the cause of AIDS.

HIV first emerged as a threat to humanity in the early 1980s. It spread so fast that initially there were fears that it might wipe us all out. Happily, there now seems no danger of that. But regrettably, many people haven't realised that this virus still remains a threat to much of the population.

Look at the latest national statistics.

In the UK, the number of people who are living with HIV has doubled in the last decade.

About 110,000 people living in Britain have the HIV virus.

Many of them do not know it – about one in five (which means over 20,000 people) is undiagnosed.

A third of the British people who are living with HIV are women – which disproves the notion that 'only men get it'.

Each year in the UK, almost 7,000 people are diagnosed as having HIV.

While about 55 per cent of them are gay males, about 45 per cent are 'straight' men and women. Incidentally, gay women are no more likely than straight women to get HIV.

The worldwide situation

Currently, the worldwide situation is this.

About 37 million people have HIV.

Almost half of these are women (who mostly got the virus from vaginal intercourse).

Nearly three million children have the virus.

Each year, about 2.3 million people catch HIV (partly because of the wider use of condoms).

Of the 37 million who have HIV, only about 15 million have any access to treatment.

In some countries, particularly those located in Sub-Saharan Africa, the HIV rates are very high. For instance, in the Republic of South Africa it's estimated that about 11 per cent of the population is HIV-positive. Therefore, you should bear in mind that having sex with a new partner in certain areas of the globe could be very dangerous.

Please note that there are now known to be two types of HIV – called HIV-1 and HIV-2. The latter one is more common is some parts of the world, notably West Africa.

What are the common myths about HIV?

Many people believe the following stories that have become commonplace during the 35 years since HIV first emerged.

'You can tell if someone is HIV-positive by looking at them'. This is nonsense. The great majority of people with HIV look perfectly normal.

'You can't get HIV from straight sex'. This isn't true. Worldwide, vaginal intercourse is now the most common way of acquiring the virus.

'Only gay men get HIV'. This is also untrue. As you can see from the figures above, large numbers of heterosexual men and women get it.

How does HIV infect people?

There are four main ways in which it can enter the body.

During sex. Rectal intercourse is a very 'efficient' way of transmitting the virus from one person to another. But nowadays, the majority of infections worldwide are caused by vaginal intercourse with an infected person.

Through sharing injection needles. Intravenous drug users are at particular risk, if they use needles that have already been used by someone else and which therefore may be contaminated with the virus.

From infected blood products. In some parts of the world blood intended for transfusion is still not tested for HIV. However, this is NOT the case in the UK.

Though infection of a baby by its mother.

A tiny number of cases occur for other reasons, for instance as a result of organ donation or sperm donation from a person who is HIV-positive, though these occurrences are very unlikely in the UK.

How does HIV attack the human body?

HIV cannot live on its own in the environment. So, in order to survive, the virus has to attack other living cells and use their metabolism to make copies of itself.

Unfortunately, HIV attacks some of the human cells that are vital to a healthy immune system, including the white blood cells known as T-helper cells or CD4 cells.

At the start of HIV infection – the primary infection – there are two possible outcomes. You can either have a short, flu-like illness that occurs one to six weeks after infection, or you can have a so-called 'dumb' infection, with no symptoms at all.

However, even if you don't have any symptoms, you can still infect other people.

Six to 12 weeks after the infection, the white blood cells have produced so many antibodies against HIV that they can be measured by a blood test. If you have HIV antibodies in your blood, you are now HIV-positive (HIV+).

An infected person will probably feel well for a long time. But the infection is still active inside the body and the virus, which can infect and destroy new blood cells, is constantly being produced.

The number of T-helper cells in the blood will slowly be reduced and when, after a number of years, the immune system has been weakened, the infected person will start showing symptoms of AIDS.

What is AIDS?

AIDS means 'acquired immune deficiency syndrome'.

It's a condition that sets in when the HIV virus has killed so many T-helper cells that the immune system is no longer able to recognise and react to attacks from everyday infections.

HIV may also attack the nervous system, possibly causing dementia. And it may affect the skin, on which small tumours develop. This condition is known as Kaposi's sarcoma.

so-called 'opportunistic infections' – serious infections by micro-organisms of the type normally defeated by the immune system. These in turn could lead to a number of related illnesses, such as cancer or dementia. Tuberculosis may also occur.

In the end, the disease can become so serious that the infected patient dies. However these days, because of modern treatment many people survive.

Who is particularly at risk?

It's common for HIV-campaigners to say that 'we are all at risk'.

Technically, this may be so. But in reality, there are many factors that affect your level of risk.

For instance, if you live in a part of the world where HIV is still rare and you only have sex with your spouse (or don't have sex at all), you're really not remotely likely to get it.

In the UK, people who are at 'above-average' levels of risk include the following.

Heterosexual men and women who do not practise safe sex, especially if their partners originate from areas of the world where HIV is widespread – Africa (south of the Sahara Desert), parts of Asia and a few of the Caribbean Islands.

Homosexual and bisexual men, who go in for anal sex with many different partners and who do not practise safe sex.

Women who have unprotected sex with many different partners, especially if these include bisexual men or intravenous drug users.

'Straight' men who have unprotected sex with many different partners.

Prostitutes who don't practise safe sex. Also at risk are their customers and these customers' other sexual partners.

People who have had many blood transfusions overseas or who were treated with blood products before 1985.

How do you avoid infection?

Use a condom. This is not a guaranteed method of avoiding infection, but using a condom reduces the risk considerably. It must be worn all the way through sex.

Avoid using recreational drugs that are injected with a syringe. Do not share syringes or needles with others.

Avoid blood transfusions in certain countries, where they may not test the blood for HIV.

In 2015, it was first suggested that taking a drug called Truvada could reduce the risk of getting HIV by 86 per cent, but much more research needs to be done on this.

What is Truvada? And what is 'PrEP'?

Truvada is a combination of two anti-retroviral drugs (tenofovir and emtricitabine).
In the USA, it has been approved for 'Pre-Exposure Prophylaxis' (now known as PrEP') against HIV. Results of scientific trials vary, but in one study the risk of infection was reduced by 42% in 'high-risk' gay men.

PrEP is intended to help protect people who are HIV-negative, but who are leading a lifestyle that makes them pretty liable to catch HIV. In Britain, you can now get it via certain websites, but we feel that it seems wiser to obtain it from a doctor who is expert in the field of HIV.
Truvada only works when it is taken regularly. Its use should be accompanied by careful medical counselling.

I might be infected – what should I do?

If you have been exposed to infection, you should contact a doctor as soon as possible for advice, testing and treatment.

In the UK, the best place to go is a genitourinary medicine (GUM) clinic or specialised HIV clinic because they're used to dealing with possible HIV cases. Also, their technical facilities are very good indeed.

Traditional HIV tests don't become positive some time after exposure to infection. But newer tests are now coming in, and these can provide an earlier diagnosis (see below).

If you know or suspect that your partner is HIV-positive or if you have been exposed to infection by accident – for instance through pricking yourself with a contaminated needle – treatment will be started to prevent an actual HIV infection. To be effective, it must commence within 72 hours of exposure.

The treatment may have some side-effects, so before going ahead the real risk of infection should be estimated.

This decision is up to you and your local HIV consultant.

How do I get tested?

If you're going to have an HIV test: you should talk to a doctor or counsellor first, in order to discuss the possible implications of the result.

Under the NHS, an HIV test at a GUM clinic is free of charge and confidential.

Also, you can go to medical charities, like the Terrence Higgins Trust. And you can have a free HIV test arranged by your GP, but this will appear on your medical records for the rest of your life.

Some people go for private HIV tests at one of the many commercial clinics that advertise their services in London and other large cities.

Currently, the routine test will cost you anything between £60 and an eye-watering £2,100 (includes counselling). The clinic shouldn't tell anyone else the result unless you authorise them to.

'Do-It-Yourself' HIV tests are now legal in the UK, but there are doubts about them because (according to the American FDA), they have a high rate of 'false negatives.' Also, you really need to have an expert to interpret the test findings.

Testing for HIV

Please note that tests don't become positive until several weeks after exposure. So there's no point in asking for one on the morning after.

Currently, there are four basic types of HIV test:

The ordinary blood test: a doctor or nurse takes a sample of blood from one of your veins, and sends it to the lab. The result usually takes a few days

'Point of care' test. This is done at a clinic, using either a tiny spot of blood (obtained from a finger-prick) or a sample of saliva. The result is available 'while you wait.'

Home-sampling test. Using a kit, you collect a small spot of blood (or a saliva sample) and send it off in the post to a testing service.

Home-testing kit. Using this type of kit, you yourself test your blood or saliva at home. Warning: some kits (particularly foreign-made ones) are unreliable.

My recommendation: have the
blood test done by an expert doctor at a GUM clinic. He or she can then
interpret the result for you—and advise you what to do next. If you're HIV-positive, then you'll need further tests to find out how far the infection has progressed.

Treatment of HIV

If you do have HIV, you should have expert treatment from a specialist. Please don't be persuaded by alternative 'cures'. In the first years of the HIV epidemic, back in the early 1980s, there was no specific treatment. And many people died very quickly of AIDS. But today, things are very different. Treatment does not actually cure HIV infection. However, it can reduce the number of viruses in your body to such low levels that for the time being they become undetectable. A new piece of research called 'PARTNER' (due to be published in 2017) is said to suggest that a person with an undetectable viral load is fairly unlikely to pass the infection on to his or her partner. There are now over 25 drugs which are used in the treatment of HIV, and they fall into six major classes. It's common to start therapy with three medications, each drawn from a different class. Choosing which combination of anti-HIV drugs to use is a complex business. Basically, it has to be decided by a doctor who is expert in treating this condition. But you should be allowed some 'input' into the choice. Indeed, I have known several cases in which patients with HIV studied the subject so thoroughly that they themselves became highly knowledgeable about the therapy of HIV, and were able to make a valuable contribution to the management of their illnesses. In addition to anti-virus treatment, you may certainly need some of the following at times:

Specific treatment of infections occurring as a result of HIV; please note that these can include tuberculosis.

Therapy for the symptoms connected with HIV infection and AIDS, for instance treatment of nausea and loss of appetite.

What can I do for myself?

If you do not have anyone to talk to about the situation, you might like to visit your GP, a counsellor with relevant experience or a psychotherapist. You should discuss your worries and the depression, which often follows the discovery that you are HIV-positive.Your partner, if you have one, may well need counselling too.

You should be treated for all infections and illnesses that result from the HIV virus. If these are serious, you will have to go to hospital.

You should contact AIDS and HIV support groups because these organisations can be helpful.

Possible deterioration

Eventually, serious illnesses might perhaps develop as a result of HIV infection – particularly if you haven't had first-class treatment. Commonly, these include infections that are normally prevented by the immune system. They inlude:

Death may sometimes occur as a result of these illnesses. But at the present time, large numbers of HIV-positive patients are managing to avoid those complications and to remain perfectly well.

Future prospects

AIDS is not yet curable. However, many of the illnesses resulting from the condition can be treated. Even if things go badly (say, because of inadequate treatment), between 5 and 20 years may pass from the time of infection until AIDS actually develops. Fortunately, with the new types of treatment available, the survival rate has greatly improved. There are patients alive today who caught the infection over 30 years ago. So the outlook is much better than it used to be.

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